Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225100000X | Physical Therapist | | 5249 | NEW YORK | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 2904019 | OTHER | NEW YORK | AETNA PPO PROVIDER NUMBER |
| 2 | 600934000 | OTHER | | DEPARTMENT OF LABOR |
| 3 | 0026201 | OTHER | NEW YORK | CIGNA |
| 4 | 100206834602 | OTHER | NEW YORK | UNITED HEALTHCARE-MEDICAI |
| 5 | 5C7048 | OTHER | NEW YORK | HEALTHNET PROVIDER NUMBER |
| 6 | 6605247 | OTHER | NEW YORK | GHI PROVIDER NUMBER |
| 7 | 7004397 | OTHER | NEW YORK | AETNA HMO PROVIDER NUMBER |
| 8 | ========= | OTHER | NEW YORK | MPN PROVIDER NUMBER |
| 9 | ========= | OTHER | NEW YORK | UHC PROVIDER NUMBER |
| 10 | P2720801 | OTHER | NEW YORK | OXFORD PROVIDER NUMBER |
| 11 | QN6301 | OTHER | NEW YORK | EMPIRE PROVIDER NUMBER |
| 12 | 273729 | OTHER | NEW YORK | 1199 PROVIDER NUMBER |
| 13 | 58958P | OTHER | NEW YORK | HIP PROVIDER NUMBER |
| 14 | 136840 | OTHER | NEW YORK | VYTRA PROVIDER NUMBER |